Differences in systemic cancer treatment in Brazil: my Public Health System is different from your Public Health System
Author: Rafael Aliosha Kaliks, Tiago Farina Matos, Vanessa de Araujo Silva, Luciana Holtz de Camargo Barros
Objective: To identify dierences in systemic cancer therapy for the four most incident can- cers among di erent treatment centers in the PuHS and to compare these treatments to Protocol and Treatment Standards (PTS) established by the Ministry of Health (MH) as well as to the standard practiced in the private health system (PrHS). Methods: Using the Infor- mation Access Law, we collected information regarding systemic treatment guidelines from public cancer centers. We compared the treatment guidelines to the PTS for breast, lung, colorectal and prostate cancer, categorizing the treatments as adequate, above or below standard. We also compared the local treatment guidelines to the standard treatments in the PrHS. Results: Of 52 cancer centers that responded to the request, 18 did not have treatment guidelines for any of four tumor types. Local treatment guidelines for lung cancer (by 29 centers), breast cancer (33 centers), colorectal cancer (31 centers) and prostate cancer (33 centers) were obtained. We identi ed sub-standard treatment as compared to the one recommended in the PTS in 16 centers for lung and 8 centers for breast cancer, and a treat- ment standard better than the PTS in 8, 13, 10 and 14 centers for lung, breast, colorectal and prostate cancer, respectively. We also identi ed di erences in treatment between centers from a same city for all four types of tumors. Few centers o er treatments equivalent to that practiced in the PrHS, though the majority o er sub-standard therapy in this comparison. Centers from all regions were heterogeneous in terms of treatment guidelines. Conclusions: We con rm there are major di erences in systemic cancer therapy for the four most incident cancers between cancer centers in the Public Health System (PuHS) in Brazil. Moreover, treated ment o ered at these public cancer centers can be below the standard established by the Ministry of Health, and well bellow the standard practiced in the PrHS.